This assumption may have delayed awareness of the need for a robust framework focused on safety alone.

Perhaps more important, these studies brought to light the critical concept of systemness, which recognizes that health care is a collection of disparate fragmented parts with many individual actors, each seeking to do their best by the patient instead of health professionals within a comprehensive “system.” This lack of systems to improve coordination in part fostered the promulgation of poor-quality, unsafe health care. Although the attention to systems of care have increased greatly, many of the efforts in the 10 years since To Err Is Human and Crossing the Quality Chasm have focused on processes of care as a first step, with the end goal of creating a comprehensive system of high-quality and safe care. These studies and those in the next section focused on quality and safety in health care overall. This background is needed to understand the context for discussing patient safety related to health information technology (health IT).2


More than 10 years since these landmark patient safety reports, there is considerable controversy about how much improvement in safety has actually occurred. Clearly some progress has been made with respect to specific processes, such as high rates of prescribing beta-blockers at discharge to patients presenting with an acute myocardial infarction (Chassin et al., 2010), and significantly reduced surgical mortality rates (Neily et al., 2010). Nationwide efforts were undertaken to reduce the number of medical errors in all care settings, and campaigns were developed to increase awareness, reduce risk factors, and develop a framework for high-quality care.

Despite these efforts, quality improvement throughout much of the U.S. health care system is still proceeding at a glacial pace. The National Healthcare Quality Report by the Agency for Healthcare Research and Quality (AHRQ) revealed that while nearly two-thirds of 179 measures of health care quality did show improvement, the median annual rate of change was only 2.3 percent. Several quality measures relating to cancer screening and diabetes management actually worsened during this time (AHRQ, 2010).

In terms of safety, several new studies have recently been published suggesting


2 Health IT is a term that is used somewhat interchangeably with other terms such as health information systems, health information and communications technology, and informatics. The terms are not necessarily defined the same way; for example, informatics–defined as a scientific field that draws upon the information sciences and related technology to enhance the use of the knowledge base of the health sciences to improve the health of individuals and populations through care, basic biomedical and clinical research, education, management, and policy–is a broader field than health IT. This report employs the term health IT but recognizes these other, broader terms are also used.

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